Lauria G, McArthur J C, Hauer P E, Griffin J W, Cornblath D R
Institute of Neurology, University of Ferrara, Italy.
J Neurol Neurosurg Psychiatry. 1998 Nov;65(5):762-6. doi: 10.1136/jnnp.65.5.762.
To describe the neuropathological features in skin biopsies from patients with diabetic truncal neuropathy.
Three patients with diabetic truncal neuropathy underwent skin biopsies from both symptomatic and asymptomatic regions of the chest and trunk. After local anaesthesia, biopsies were performed using a 3 mm diameter punch device (Acupunch). Intraepidermal nerve fibres (IENFs), the most distal processes of small myelinated and unmyelinated nerve fibres, were identified after staining with PGP 9.5 as previously described.
Diabetes was diagnosed at the time of the neurological presentation in two, and one was a known diabetic patient. All three had associated sensory-motor polyneuropathy. In all, skin biopsies showed a marked reduction of both epidermal and dermal nerve fibres in the symptomatic dermatomes, compared with skin from asymptomatic truncal areas. In one patient, a follow up skin biopsy when symptoms had improved showed a return of IENFs.
In diabetic truncal neuropathy, skin biopsies from symptomatic regions show a loss of IENFs. After clinical recovery, there is a return of the IENF population, suggesting that improvement occurs by nerve regeneration. These findings suggest that sensory nerve fibre injury in diabetic truncal neuropathy is distal to or within the sensory ganglia. Skin biopsy provides a possible tool for understanding the pathophysiology of the disease.
描述糖尿病性躯干神经病患者皮肤活检的神经病理学特征。
3例糖尿病性躯干神经病患者在胸部和躯干的有症状及无症状区域进行皮肤活检。局部麻醉后，使用直径3毫米的打孔器（Acupunch）进行活检。如前所述，用PGP 9.5染色后识别表皮内神经纤维（IENF），即有髓和无髓小神经纤维的最远端分支。
2例患者在出现神经症状时被诊断为糖尿病，1例为已知糖尿病患者。3例均伴有感觉运动性多发性神经病。总体而言，与无症状躯干区域的皮肤相比，有症状皮节的皮肤活检显示表皮和真皮神经纤维均显著减少。1例患者在症状改善时进行的随访皮肤活检显示IENF数量恢复。
在糖尿病性躯干神经病中，有症状区域的皮肤活检显示IENF缺失。临床恢复后，IENF数量恢复，提示改善是通过神经再生实现的。这些发现表明糖尿病性躯干神经病中的感觉神经纤维损伤位于感觉神经节远端或感觉神经节内。皮肤活检为理解该疾病的病理生理学提供了一种可能的工具。
